OBH/AEE Accreditation Standards
How the Standards were Created?
This document underwent a series of three extensive review processes. First, the current AEE Accreditation standards were integrated with applicable OBH content by Dr. Neal Christensen of the Outback Therapeutic Expeditions program and Dr. Michael Gass of the University of New Hampshire in the Spring of 2013. Their work was reviewed and edited by Dr. Maddy Liebing of the Journey Program and Patrick Logan of Second Nature. A third round of reviews were conducted by the OBHC Accreditation subcommittee, facilitated by Jon Baker from the Second Nature Program. Charles “Reb” Gregg, Esq., also provided legal feedback on several standards. This entire step of the process took 10 months but added great richness, depth, and consensus by the committee.
Second, the document was reviewed by a panel of 10 national experts for validation and further analysis of the Standards. This panel was composed of Steven Pace and Denise Mitten from Prescott College, Paula Lesiie from Erkis Consulting, Paul Smith serving as Chair of the AEE Standards Committee, Jon Baker serving as Chair of the OBHC Accreditation Committee, Dr. Maddy Liebing from the Journey Program, Gil Hallows from the Legacy Program, Shawn Tierney as Director of Accreditation from AEE, and facilitated by Dr. Michael Gass from the University of New Hampshire.
Third, the OBH AEE standards were further reviewed by content specialists for specific feedback on certain standards of their expertise as well as an overall “read” of the document. These individuals included Jed Williamson, one of the authors of the original set of standards for adventure programs and former President of Sterling College; Sky Gray, Executive Director of the Santa Fe Mountain Center and former Director of AEE Accreditation program; Maurie Lung, current President-elect of the AEE Board of Directors, Paul Smith, current chair of the AEE Accreditation Council, and Dr. Anita Tucker, Associate Professor of Social Work at the University of New Hampshire.
What do the Standards Cover?
The 85 page set of standards covers six critical areas for OBH programs. These areas include program principles, governance, management, land technical activities, water technical activities, and miscellaneous technical activities. Each of these areas is further broken down into specific sections. The first section on program principles covers philosophical, therapeutic, educational, and ethical principles. The second section on program governance examines the soundness and stability of the organization. The third section covers program management, operations, and oversight - especially in areas of risk management, supervision, screening, human resources, staffing, and therapeutic treatment. The fourth section covers 21 technical land activities. The fifth section reviews 10 water activities. The sixth section covers other technical activities not covered in other sections (e.g., solos, service projects).
Sample of Standards
1.03 Appropriate therapeutic methods are used to enable clients to develop cognitive, affective, and behavioral elements of their experiences.
Explanation: Therapeutic growth as a result of experience is not automatic. Therapeutic growth is intended to have present, as well as future, relevance for the client. In order to enhance assimilation of material, OBH therapy includes observation and reflection regarding an experience. This process can be achieved in a number of ways, including dialogue, group discussion, writing, drawing, etc. The use of activity in conjunction with reflective processes allows the client to grow or change more effectively. OBH methods that are most likely to benefit clients should be used. These methods should be structured to take into account the client’s background, history, and presenting issues (e.g. diagnosis, current mental state, level of functioning). OBH methods should be grounded in historical approaches, evidence-based practice, and theory. This can be achieved in many ways including individual or group therapy, processing experiences, writing, etc. The benefits of the experience are intended to improve client functioning, promote better health, initiate positive growth, and the benefits should be transferable to other settings.
2.02 Staff members conduct their work with competence and practice within the boundaries of their respective qualifications.
Explanation: This standard does not address staff members’ qualifications, per se; rather, it addresses ethical standards by which staff members conduct themselves. Staff members strive to maintain high standards of quality and performance in their work; seek appropriate education; participate in ongoing training; maintain current knowledge; hold appropriate credentials; and exercise reasonable judgment in the conduct of their work. Staff members also recognize the boundaries of their competence and do not provide services outside of those boundaries. Staff members provide services only after undertaking appropriate education; participating in ongoing training; and seeking appropriate supervision, consultation, or advice where necessary. When practicing in areas where standards or guidelines do not exist, staff members take reasonable steps to develop the skills necessary for appropriate practice or services.
4.19: The program has a policy identifying how medication will be carried, secured, and administered in the field.
Explanation: Because many programs carry emergency medications and clients and staff members may be taking prescription medications in the field, it is important that the program has a system for communicating to staff members and clients how it will handle the carrying, securing, administration, and documentation of these medications. For example, the program might need to identify whether or not its policies allow for providing over-the-counter medications to clients. The program also identifies documentation procedures required if medications are used. The program follows applicable law(s) and/or associated training requirements.
4.20: The program has policies and procedures regarding medication management of its clients and staff members.
Explanation: Clients and staff members may have prescriptions for psychotropic medications. The program should have a methodology for determining the impact and appropriateness of these medications for their program. It may be determined that some medications are not appropriate for OBH practiced in wilderness environments. Medication administration records may be necessary and may need to include information on contraindications and common side effects. The program will have policies and procedures in place for staff members who are on medication and/or have medication in their possession while working with students.
4.25: The program has crisis management protocols to secure the safety of participants, group, and staff members during emergent psychological, psychiatric, and/or behavioral issues.
Explanation: Clients may become suicidal, homicidal, and/or attempt to run away from the program. These issues pose a risk to the participant, other group members, and personnel. The program has appropriate procedures for addressing these issues.
4.26: The program has policies and procedures that address the use of non-violent crisis intervention, therapeutic hold techniques, and restraints.
Explanation: Participants in OBH programs may present a risk to themselves or others. These situations may require specialized measures of care and attention. These may include struggles with anger, impulsivity, and violent behavior. Concurrently, staff members working with these populations are at risk for abuse or assault in the workplace. Given these circumstances it is critical that the program has given attention and training to its staff members regarding its policies and procedures about de-escalation techniques, therapeutic hold and restraint.
5.05: Mental health professionals are hired who are academically and professionally trained and licensed to manage mental health issues with client populations they serve.
Explanation: Mental health professionals may diagnose; develop treatment plans; identify, design, and execute treatment interventions; supervise staff members who implement interventions; and develop recommendations and transition plans. All mental health professionals follow their level of training and do not exceed mental health practices for which they are trained.
For example, recreational therapists, Licensed Substance Abuse Counselors, and other similar “adjunct” specializations do not fill the role of primary therapist due to their lack of appropriate training in psychotherapy, diagnosis, and license limitations. Approved credentials and licenses include masters and doctoral level mental health professionals in treatment fields including clinical psychology, counseling psychology, counseling, marriage and family therapy, psychiatry, and social work.
5.12: Licensed mental health professionals provide direct client care, supervise treatment, and conduct training of staff members.
Explanation: In order to ensure adequate and expected levels of care, licensed mental health professionals need to be active in the treatment of clients under their care. The mental health professional meets with the client, completes a mental health assessment, formulates diagnoses, develops a treatment plan and interventions based on direct client information, and conducts individual and group therapy. He/she also provides professional consultation to staff members that are supporting client treatment. These responsibilities cannot be delegated to non-licensed personnel.
5.13: Mental health professionals are engaged in on-going supervision and consultation in the program when feasible, and outside the program if needed.
Explanation: Behavioral healthcare can often be emotionally fatiguing for the professional, and personal issues of the professional can sometimes interfere with work with the client. It is imperative that mental health professionals remain engaged in a peer-process of supervision and consultation to maintain objectivity and support their personal health and professional growth.